POS0575 CAPACITY OF SIX DIFFERENT CARDIOVASCULAR RISK ALGORITHMS FOR THE DETECTION OF CAROTID PLAQUE IN RHEUMATOID ARTHRITIS
Authors: N. Guajardo-Jauregui, I. J. Colunga-Pedraza, D. Á. Galarza-Delgado, J. R. Azpiri-López, A. Cárdenas, A. N. Garza-Cisneros, A. Garcia-Heredia, M. A. Balderas-Palacios, A. B. Rodriguez-Romero
Journal: Annals of the Rheumatic Diseases (2022)

Background Current EULAR recommendations for cardiovascular risk (CVR) assessment in rheumatoid arthritis (RA) indicate that the CVR evaluation should be performed according to national guidelines; however, there was no algorithm designed for the Mexican population until 2019, when the World Health Organization (WHO) published the CVR charts for 21 world regions, including Mexico (1). Objectives To determine the capacity of the WHO and other five algorithms for the detection of carotid plaque (CP) in RA patients. Methods Cross-sectional study. We included 164 patients with RA diagnosis according to the 2010 ACR/EULAR classification criteria, aged 40-75 years. CVR was calculated with six algorithms: WHO, FRS-lipids, FRS-BMI, SCORE, ACC/AHA and QRISK3. Carotid ultrasound was performed in all patients to identify the presence of CP. A ROC-curve analysis was performed, and the cutoff points of each algorithm were determined using the Youden Index. Area under the curve (AUC), sensitivity, specificity, and likelihood ratios (LR) were calculated. A p -value &lt;0.05 was considered statistically significant. Results The prevalence of CP was 35.9%. The WHO algorithm showed AUC: 0.729 (0.649-0.809), cutoff point: 5.25, sensitivity: 72.9%, and specificity: 64.8%. FRS-lipids showed AUC: 0.684 (0.601-0.767), cutoff point: 8.62, sensitivity: 67.8%, and specificity: 61.0%. FRS-BMI showed AUC: 0.700 (0.618-0.781), cutoff point: 11.55, sensitivity: 72.9%, and specificity: 61.0%. SCORE showed AUC: 0.687 (0.601-0.773), cutoff point: 1.5, sensitivity: 79.7%, and specificity: 45.7%. ACC/AHA showed AUC: 0.687 (0.604-0.770), cutoff point: 3.82, sensitivity: 62.7%, and specificity: 61.0%. QRISK3 showed AUC: 0.733 (0.654-0.811), cutoff point: 6.05, sensitivity: 71.2%, and specificity: 61.0%. All algorithms had a p -value &lt;0.001 (Figure 1 and Table 1). Table 1. Capacity of cardiovascular risk algorithms to detect presence of carotid plaque in rheumatoid arthritis patients Algorithms (cut-off points) AUC CI 95% p Sensibility Specificity Likelihood radio Inferior limit Superior limit + - WHO 0.729 0.649 0.809 &lt;0.001 72.9% 64.8% 2.07 0.42 (5.25) FRS-lipids 0.684 0.601 0.767 &lt;0.001 67.8% 61.0% 1.74 0.53 (8.62) FRS-BMI 0.700 0.618 0.781 &lt;0.001 72.9% 61.0% 1.87 0.44 (11.55) SCORE 0.687 0.601 0.773 &lt;0.001 79.7% 45.7% 1.47 0.44 (1.5) ACC/AHA 0.687 0.604 0.770 &lt;0.001 62.7% 61.0% 1.61 0.61 (3.82) QRISK3 0.733 0.654 0.811 &lt;0.001 71.2% 61.0% 1.82 0.47 (6.05) AUC, area under the curve; WHO, World Health Organization; FRS, Framingham Risk Score; BMI, body mass index. Conclusion The WHO calculator was one of the best algorithms for the detection of CP, with the best positive and negative likelihood ratios; however, like the other algorithms, a lower cut-off point than the one established by official guidelines was needed to identify high-risk patients with the presence of CP, who were initially classified as low-moderate risk by the CVR algorithm. References [1]Group WCRCW. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Health. 2019;7(10):e1332-e45. Disclosure of Interests None declared.